To investigate the diagnostic performance and incidental lesion yield of 3T breast MRI if used as a problem-solving tool.
This retrospective, IRB-approved, cross-sectional, single-center study ...comprised 302 consecutive women (mean: 50±12 years; range: 20-79 years) who were undergoing 3T breast MRI between 03/2013-12/2014 for further workup of conventional and clinical breast findings. Images were read by experienced, board-certified radiologists. The reference standard was histopathology or follow-up ≥ two years. Sensitivity, specificity, PPV, and NPV were calculated. Results were stratified by conventional and clinical breast findings.
The reference standard revealed 53 true-positive, 243 true-negative, 20 false-positive, and two false-negative breast MRI findings, resulting in a sensitivity, specificity, PPV, and NPV of 96.4% (53/55), 92.4% (243/263), 72.6% (53/73), and 99.2% (243/245), respectively. In 5.3% (16/302) of all patients, incidental MRI lesions classified BI-RADS 3-5 were detected, 37.5% (6/16) of which were malignant. Breast composition and the imaging findings that had led to referral had no significant influence on the diagnostic performance of breast MR imaging (p>0.05).
3T breast MRI yields excellent diagnostic results if used as a problem-solving tool independent of referral reasons. The number of suspicious incidental lesions detected by MRI is low, but is associated with a substantial malignancy rate.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective
This study was performed to determine whether add-on oral ivabradine in patients treated with beta blockers 1 hour before coronary computed tomographic angiography (CCTA) is effective in ...lowering the heart rate and thus improving CCTA quality.
Methods
In this single-center cohort study, the data of 294 patients referred for ambulant CCTA were retrospectively screened. Patients with an initial heart rate of ≥75 bpm (n = 112) were pretreated with either a combination of bisoprolol and ivabradine or with bisoprolol alone.
Results
During the scan, there was no difference in heart rate between the two groups Likewise, there was no significant difference in additionally administered intravenous bradycardic agents, the number of motion artifacts, or the radiation dose. Both drug regimens were tolerated well.
Conclusion
Additive oral ivabradine 1 hour before CCTA does not result in a further reduction of the heart rate. Consequently, neither movement artifacts nor radiation dose can be reduced. Therefore, pretreatment with ivabradine does not seem reasonably appropriate in an outpatient clinical setting with short patient contact.
The aim of this study was to evaluate the potential of multiphasic multidetector-row CT (MDCT) in the detection and staging of transitional cell carcinomas (TCC) of the upper urinary tract. We ...performed a retrospective chart review of 39 consecutive patients with 41 histologically verified TCC of the renal pelvis and/or the ureter. The urinary tract was examined using MDCT performing unenhanced and contrast-enhanced scans during the corticomedullary (CMP), nephrographic (NP) and pyelographic phase (PP). Tumors were staged according to the TNM classification. MDCT and histopathological findings were correlated. The attenuation of the lesions was documented in Hounsfield units (HU). In MDCT, all 41 TCC--including two multicentric TCC--were detected. TCC confined to the organ (stage 0a-II) was correctly staged in 28/29 tumors (96.6%). Stage III-IV tumors were correctly staged in 8/12 patients (66.6%). Overall, MDCT was accurate in predicting pathologic TNM stage in 36/41 upper urinary tract TCC (87.8%). There was no significant difference of mean attenuation of TCC between CMP, NP and PP (P > 0.05). MDCT with its high spatial and temporal resolution is an accurate tool for detection TCC of the upper urinary tract, with 87.8% accuracy in predicting its stage.
Objective
To assess the effect of oral hydration and contrast-medium volume on renal enhancement and urinary tract opacification in multi-detector CT urography.
Methods
A total of 192 patients were ...assigned to different protocols with varying doses of contrast agent with and without oral hydration. The attenuation was measured in the renal parenchyma in the unenhanced, nephrographic and excretory phase, and in the urinary tract in excretory phase imaging, respectively. Opacification of the urinary tract was graded on volume rendered images.
Results
Oral hydration did not significantly alter renal parenchymal enhancement in both the nephrographic and the excretory phase (
p
> 0.001), but significantly decreased mean attenuation of the urinary tract in the excretory phase (
p
≤ 0.001), and improved continuous opacification of all ureter segments (
p
< 0.01). Higher volumes of contrast medium improved renal parenchymal enhancement (
p
≤ 0.001) and continuous opacification of the urinary tract (
p
≤ 0.01).
Conclusion
Oral hydration leads to lower attenuation values in the urinary tract but improves the continuous opacification of the tract. Increase in contrast medium volume leads to higher renal parenchymal enhancement as well as to an increased continuous opacification of the urinary tract. Decrease in contrast medium volume cannot be compensated for by oral hydration in terms of parenchymal enhancement.
The purpose of this study was to assess whether body weight, body mass index, and scan length influence arterial enhancement during CT angiography (CTA) of the pulmonary arteries at different iodine ...flow rates.
CTA examinations of the pulmonary arteries performed for routine clinical care of 120 patients between March and December 2003 were retrospectively evaluated. Patients had received either 120 mL of contrast medium with an iodine concentration of 300 mg I/mL (group A) or 90 mL of contrast medium with an iodine concentration of 400 mg I/mL (group B). The iodine dose was 36 g, and the injection rate was 4 mL/s in all examinations. The iodine flow rate was 1.2 g I/s in group A and 1.6 g I/s in group B. Arterial attenuation along the z-axis was measured per patient, and the influence of body weight, body mass index, and scan length on enhancement of the pulmonary arteries in the two groups was assessed.
In group A and in group B, body weight and body mass index correlated significantly with mean enhancement along the z-axis (r = -0.35 and -0.26 for group A and -0.48 and -0.40 for group B). Scan length showed no correlation with pulmonary attenuation. Mean pulmonary artery enhancement was significantly higher in group B with a difference of 51 H compared with group A.
Pulmonary artery attenuation in CTA of the pulmonary arteries shows a small but significant correlation with body weight and body mass index independently of the iodine flow rate used. A higher iodine flow rate improves pulmonary artery enhancement.
Our objective was to assess the influence of iodine flow concentration on attenuation and visualization of the pulmonary arteries in thoracic MDCT angiography.
One hundred consecutive patients who ...were referred to our department with suspected acute pulmonary embolism underwent MDCT angiography of the pulmonary arteries either with 120 mL of standard contrast medium (300 mg I/mL) (group A) or with 90 mL of high-concentration contrast medium (400 mg I/mL) (group B). The contrast medium was injected at a flow rate of 4 mL/sec. The scan delay was determined using a semiautomatic bolus-tracking system in all examinations conducted with the same scanning parameters. Quantitative analysis was performed by region-of-interest measurements along the z-axis to compare the attenuation profiles of the two groups. Attenuation of the fourth-, fifth-, and sixth-order arteries was assessed visually for differences between the two groups.
The mean enhancement along the z-axis was 268 +/- 56 H in group A and 344 +/- 108 in group B. The difference of 76 H was statistically significant (p < 0.001). The attenuation profile was similar in both groups. The detection rate of fifth- and sixth-order arteries was significantly higher in group B than in group A (94% compared with 91% and 72% compared with 60%, respectively, p < 0.01).
Use of a high flow concentration of iodine in MDCT angiography of the pulmonary arteries significantly increases attenuation of the pulmonary arteries, thereby improving visualization of subsegmental pulmonary arteries.
Objective: The purpose of this study was to examine the effect of aortoiliac tortuosity, as assessed by observers and 3-dimensional (3D) computer-based methods, on the conduct and outcome of ...endovascular repair of abdominal aortic aneurysms. Methods: Infrarenal aortoiliac tortuosity was measured in 75 patients (mean follow-up, 14.8 ± 10.4 months) who underwent endovascular repair of abdominal aortic aneurysms by using the following four methods: (1) grading by 2 experienced observers; (2) tortuosity index measured as the inverse radius of curvature (cm–1) at 1-mm intervals along the median luminal centerline (MLC) on 3D reconstructions of computed tomography (CT) angiograms and was calculated as the sum of values greater than 0.3 cm–1; (3) MLC–straight line length ratio from renal to hypogastric arteries; (4) manual measurement of angles at points of angulation on anteroposterior and lateral projections of 3D CT reconstructions. In evaluating association between these measures, correlation between human observers was accepted as the gold standard. Results: For rating of overall aortoiliac tortuosity, interobserver correlation (r = 0.67) was comparable with correlation of observers with tortuosity index (r = 0.67 and 0.56), whereas correlations of each observer with MLC–straight line ratio (r = 0.50 and 0.56) and cumulative angulation (r = 0.44 and 0.44) were significant but weaker. For determining the relative tortuosity of right and left aortoiliac access, agreement between observers and tortuosity index (54% and 58%; P <.05; κ, 0.33 and 0.38) was not as good as between observers (68%; P <.001; κ, 0.53). This difference was primarily related to evaluation of the aorta, where interobserver correlation (r = 0.71) was better than that between each observer and tortuosity index (r = 0.47 and 0.55), whereas correlations in the iliac arteries were comparable (r = 0.64 and 0.67) (all coefficients P <.01). Increased tortuosity was associated with a more complex endovascular repair, as reflected by longer fluoroscopy time (P =.05), use of more contrast material (P =.03), use of extender modules (P =.04), and more frequent use of arterial reconstruction (P =.01), but was not associated with a higher overall complication rate. Increased tortuosity, when it occurred in the aortic neck, was associated with predischarge endoleak (P =.03) but not with late endoleak, intervention, or aneurysm-related adverse events. Conclusion: Aortoiliac tortuosity is associated with increased complexity of endovascular aneurysm repair and with predischarge endoleak but does not appear to affect intermediate-term results. Computer-based 3D measurement of aortoiliac tortuosity is feasible and clinically meaningful. Its ultimate role in relation to human assessment must be further defined in future studies. (J Vasc Surg 2001;34:594-9.)
Objectives
To assess the frequency of anterolateral ligament (ALL) tears and ramp lesions (RL) detected with MRI in patients with anterior cruciate ligament (ACL) tears and to describe associated ...injuries indicative for these lesions.
Methods
In this retrospective study, 164 patients with surgically verified ACL tears were included. Preoperative MRI scans were reviewed for ALL tears and different types of RL. All coexisting meniscal tears, tears of the medial (MCL) and lateral collateral band (LCL), and posterior-medial tibial bone marrow edema (BME) were recorded. The frequency of ALL tears and RL was assessed and coexisting injuries were correlated using Pearson’s chi-square test. A
p
< 0.05 was defined as statistically significant. In cases of multiple testing, Bonferroni’s correction was applied.
Results
ALL tears and RL combined were detected in 28 patients (17.1%), ALL tears in 48 patients (29.3%), and RL in 54 patients (32.9%) which were significantly associated to each other. ALL tears were significantly associated with tears of the posterior horn of the lateral meniscus (PHLM), BME, and with tears of the LCL and MCL. RL were significantly associated with tears of the posterior horn of the medial (PHMM) and PHLM, with BME, and with tears of the LCL.
Conclusions
ACL tears are associated with RL or ALL tears in about one-third of cases and with both lesions combined in about one-fifth of cases. ALL tears and RL are significantly associated with additional posttraumatic injuries, which can thus be indicative of these lesions.
Key Points
• ACL tears were associated with ramp lesions or ALL tears in about one-third of the cases.
• Ramp lesions and ALL tears were significantly associated with each other, tear in the PHLM, tear in the LCL, and BME.
• ALL tears were more frequently associated with instable classified ramp lesion type 4b and type 5.
Sugars including lactose and fructose, or proteins (gluten), or biogenic amines (histamine), and combinations thereof may cause food intolerance/malabsorption. However, in usually asymptomatic ...patients with rare diseases, who present with functional, non-specific, non-allergic gastrointestinal (GI) complaints the etiologic factors of food intolerance/malabsorption need to be evaluated. We summarize patients with rare diseases, such as primary epiploic appendagitis, beta-thalassemias minor, Gullo syndrome and anomaly of the inferior vena cava, who presented functional, non-specific, non-allergic GI complaints. As conclusion, these GI symptoms in patients with otherwise asymptomatic, rare diseases were due to fructose malabsorption, histamine-, lactose intolerance and Helicobacter pylori (H.p.) infection. A registered and experienced dietician was employed to design an individually-tailored diet which ensured effective treatments and H.p. infection was accordingly eradicated.
Abstract Objective To assess the influence of the lower threshold for segmentation of the volume of interest on the perfusion values in first-pass dual input volume CT-perfusion of lung lesions. ...Materials and methods Dual input maximum slope volume CT-perfusion was performed in 48 patients (mean age ± standard deviation SD, 68 ± 10 years; range, 46 − 87 years) who underwent subsequent CT-guided biopsy to evaluate a lung lesion. Using commercial perfusion software, a lower and upper threshold was set for determination of the CT-value range, which again determined the volume of interest for perfusion calculation. The pulmonary arterial flow (PAF), bronchial arterial flow (BAF), and perfusion index (PI; PAF/(PAF + BAF)) were calculated at following pre contrast CT value range settings: −80 to 150HU (setting 1), −200 to 150HU (setting 2), −300 to 150HU (setting 3), and −500 to 150HU (setting 4). Perfusion parameters were compared between benign (n, 15) and malignant (n, 33) lesions for each setting. Intraobserver- and interobserver reliability were calculated for setting 4. Results Median PAF was significantly higher in malignant lesions than in benign lesions for all settings (53 − 96 versus 29 − 62 mL/min/100 mL, P <.05). There was no significant difference in BAF between malignant and benign lesions. Median PAF of all lesions was significantly influenced by the CT value range setting ( P < .05), whereas the values increased from setting 1 to 4. Intraobserver analysis as well as interobserver analysis of PAF at setting 4 showed excellent reliability (Cronbach’s alpha .98 and .95, respectively, P<.01 ). Conclusion PAF derived from first-pass dual-input maximum slope volume CT perfusion is statistically significantly higher in malignant than in benign lesion, whereas the measurements are influenced by the lower threshold of the CT value range setting. This has to been considered when using cutoff values provided in the literature for differentiation between benign and malignant lung lesions.
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